IVUS images are derived from a beam of ultrasonic energy projected by apparatus such as a transducer or transducer array located around, along or at the tip of a catheter inserted within a blood vessel. An ultrasound beam from the apparatus is continuously rotated within the blood vessel forming a 360.degree. internal cross sectional image, i.e., the image is formed in a transverse (X-Y) plane. Depending on the specific apparatus configuration, the image may be derived either from the same transverse plane of the apparatus or from a transverse plane found slightly forward (i.e., distal) of the transverse plane of the apparatus. If the catheter is moved inside and along the blood vessel (i.e., along the Z-axis), images of various segments (series of consecutive cross sections) of the vessel may be formed and displayed.
IVUS may be used in all types of blood vessels, including but not limited to arteries, veins and other peripheral vessels, and in all parts of a body.
The ultrasonic signal that is received (detected) is originally an analog signal. This signal is processed using analog and digital methods so as to eventually form a set of vectors comprising digitized data. Each vector represents the ultrasonic response of a different angular sector of the vessel, i.e., a section of the blood vessel. The number of data elements in each vector (axial sampling resolution) and the number of vectors used to scan a complete cross section (lateral sampling resolution) of the vessel may vary depending on the type of system used.
The digitized vectors may initially be placed into a two-dimensional array or matrix having Polar coordinates, i.e., A(r, .theta.). In this Polar matrix, for example, the X axis corresponds to the r coordinate and the Y axis corresponds to the .theta. coordinate. Each value of the matrix is a value (ranging from 0-255 if the system is 8 bit) representing the strength of the ultrasonic response at that location.
This Polar matrix is not usually transferred to a display because the resultant image will not be easily interpreted by a physician. The information stored in the Polar matrix A(r, .theta.) usually undergoes several processing stages and is interpolated into Cartesian coordinates, e.g., X and Y coordinates (A(X, Y)) that are more easily interpreted by a physician. Thus, the X and Y axis of matrix A(X, Y) will correspond to the Cartesian representation of the vessel's cross-section. The information in the Cartesian matrix possibly undergoes further processing and is eventually displayed for analysis by a physician. Images are acquired and displayed in a variable rate, depending on the system. Some systems can acquire and display images in video-display rate, e.g., up to about 30 images per second.
IVUS examination of a segment of a bodily lumen, i.e., vessel is generally performed by situating the catheter distal (i.e., downstream) to the segment to be reviewed and then the catheter is pulled back (pullback) slowly along the bodily lumen (Z-axis) so that successive images that form the segment are continuously displayed. In many cases the catheter is connected to a mechanical pulling device which pulls the catheter at a constant speed (i.e., a typical speed is approximately 0.5-1 mm/sec.).
In IVUS imaging systems today the technique described above for displaying an image of a cross section of a bodily lumen, e.g., blood vessel, is generally used. These systems are deficient, however, because they do not include any form of stabilization of the images to compensate for movements of the catheter and/or bodily lumen, e.g., blood vessel. It is well known that during IVUS imaging of a bodily lumen, there is always motion exhibited by the catheter and/or the bodily lumen. This motion might be exhibited in the transverse (X-Y) plane, along the vessel axis (Z axis) or a combination of those movements. The imaging catheter can also be tilted in relation to the vessel so that the imaging plane is not perpendicular to the Z axis (This movement shall be termed as angulation). These movements are caused by, among other things, beating of the heart, blood and/or other fluid flow through the lumen, vasomotion, forces applied by the physician, and other forces caused by the physiology of the patient.
In IVUS systems today, when the imaging catheter is stationary or when performing slow manual or mechanical pullback, relative movement between the catheter and the lumen is the primary factor for the change in appearance between successive images, i.e., as seen on the display and/or on film or video. This change in appearance occurs because the rate of change of an image due to movements is much greater than the rate of change in the real morphology due to pullback.
Stabilization occurs when the images include compensation for the relative movement between the catheter and the lumen in successive images. Because none of the IVUS systems used today perform stabilization, there is no compensation for or correction of relative movements between the catheter and the lumen. As a result, morphological features are constantly moving or rotating, i.e., on the display and/or film or video. This makes it difficult for the physician to accurately interpret morphology in an IVUS dynamic display. Furthermore, when non-stabilized IVUS images are fed as an input to a processing algorithm such as 3D reconstruction or different types of filter that process a set of successive images, this can lead to degraded performance and misdiagnosis or inaccurate determinations.
Current IVUS imaging apparatus or catheters may have occasional malfunctions of an electronic or mechanical origin. This can cause displayed images to exhibit both recognized or unrecognized artifacts and obscure the real morphology. Currently there is no automatic methods to determine whether images posses these types of artifacts which hamper the analysis of the images of the vessel or bodily lumen.
The behavior of cardiovascular function is generally periodic. The detection of this periodicity and the ability to establish correlation between an image and the temporal phase in the cardiac cycle to which it belongs is referred to as cardiac gating.
Currently, cardiac gating is performed by using an external signal, usually an ECG (Electro-Cardiogram). However, ECG gating requires both the acquisition of the ECG signal and its interleaving (or synchronization) with the IVUS image. This requires additional hardware/software.
Morphological features in IVUS images of blood vessels can be broken into three general categories: the lumen, i.e., the area through which the blood or other bodily fluid flows; the vessel layers; and the exterior, i.e., the tissue or morphology outside of the vessel. Blood in most IVUS films (images) is characterized by a rapidly changing speckular pattern. The exterior of the vessel also alternates with high temporal frequency. Currently, the temporal behavior of pixels and their textural attributes are not monitored automatically.
Vasomotion in the context of bodily lumens, e.g., blood vessel, is defined as the change in the caliber of the lumen, e.g., vessel. This change can be brought about by natural circumstances or under induced conditions. Vasomotion can have a dynamic component, i.e., dynamic change of the lumen's dimensions, e.g., vessel's caliber (contraction and dilation) during the cardiovascular cycle, and a baseline static component, i.e., a change in the baseline caliber of the lumen, e.g., vessel.
Vasomotion can be expressed as quantitative physiological parameters indicating the ability of the lumen, e.g., vessel to change its caliber under certain conditions. These types of parameters have current and possibly future medical and diagnostic importance in providing information regarding the state of the lumen, e.g., vessel and the effect of the therapy performed.
IVUS can be used to monitor vasomotion because it provides an image of the lumen's baseline caliber and its dynamic changes. Additionally, IVUS can be used to monitor whether the vasomotion is global (uniform), i.e., where the entire cross-section of the lumen contracts/dilates in the same magnitude and direction. IVUS can also be used to determine whether the vasomotion is non-uniform which leads to local changes in the caliber of the lumen, i.e., different parts of the lumen cross-section behave differently.
Currently, all types of vasomotion monitoring by IVUS are performed manually. This is tedious, time consuming, and prevents monitoring of the vasomotion in real time.
Interpretation of IVUS images is achieved through analysis of the composition of the static images and monitoring their temporal behavior. Most IVUS images can be divided into three basic parts. The most inner section is the flow passage of the lumen, i.e., the cavity through which matter, i.e., blood, flows. Around the flow passage is the actual vessel, which may include blood vessels and any other bodily vessels, which is composed of multiple layers of tissue (and plaque, if diseased). Outside the vessel other tissue which may belong to the surrounding morphology, for example, the heart in a coronary vessel image.
When the IVUS film is viewed dynamically, i.e., in film format, the pixels corresponding to matter flowing through the vessel and to the morphology exterior to the vessel exhibit a different temporal behavior than the vessel itself. For example, in most IVUS films, blood flowing through the vessel is characterized by a frequently alternating speckular pattern. The morphology exterior to the vessel also exhibits frequent alternation. Currently the temporal behavior of pixels in dynamic IVUS images is not monitored automatically.
In current IVUS displays, if designed into the system, high frequency temporal changes are suppressed by means such as averaging over a number of images. However, this sometimes fails to suppress the appearance of features with high amplitudes, i.e., bright gray values, and it also has a blurring effect.
The size of the flow passage of the lumen is a very important diagnostic parameter. When required for diagnosis, it is manually determined by, for example, a physician. This is accomplished by drawing the contour of the flow passage borders superimposed on a static image, e.g., frozen on video or on a machine display. This method of manual extraction is time consuming, inaccurate and subject to bias.
Currently, there is commercial image processing software for the automatic extraction of the flow passage. However, these are based on the gray value composition of static images and do not take into account the different temporal behavior exhibited by the material, e.g., blood flowing through the passage as opposed to the vessel layers.
During treatment of vessels, it is common practice to repeat IVUS pullback examinations in the same vessel segments. For example, a typical situation is first to review the segment in question, evaluate the disease (if any), remove the IVUS catheter, consider therapy options, perform therapy, e.g., PTCA-"balloon" or stenting, and then immediately thereafter reexamine the treated segment using IVUS in order to assess the results of the therapy. To properly evaluate the results and fully appreciate the effect of the therapy performed, it is desirable that the images of the pre-treated and post-treated segments, which reflect cross sections of the vessel lying at the same locations along the vessel's Z-axis (i.e., corresponding segments), be compared. To accomplish this comparison it must be determined which locations in the films of the pre-treatment IVUS images and post-treatment IVUS images correspond to one another. This procedure, called matching (registration) allows an accurate comparison of pre- and post-treatment IVUS images.
Currently, matching is usually performed by viewing the IVUS pullback films of pre- and post-treatment segments, one after the other or side by side by using identifiable anatomical landmarks to locate the sequences that correspond visually to one another. This method is extremely imprecise and difficult to achieve considering that the images are unstable and often rotate and/or move around on the display due to the absence of stabilization and because many of the anatomical landmarks found in the IVUS pullback film of the pre-treatment segment may be disturbed or changed as a result of the therapy performed on the vessel. Furthermore, the orientation and appearance of the vessel is likely to change as a result of a different orientations and relative positions of the IVUS catheter in relation to the vessel due to its removal and reinsertion after therapy is completed. The matching that is performed is manual and relies primarily on manual visual identification which can be extremely time consuming and inaccurate.